ASSESSING THE AVOIDABLE HEALTHCARE COSTS OF OFF-LABEL QUETIAPINE IN DEMENTIA: A RETROSPECTIVE ANALYSIS OF MIS-CHANNELLING DISPENTIONS
Author(s)
Matteo Mogliani, MSc, Maria Elena Ciccotti, MSc.
Agenzia Regionale Sanitaria, Ancona, Italy.
Agenzia Regionale Sanitaria, Ancona, Italy.
OBJECTIVES: Assessing the financial burden of suboptimal Quetiapine dispensing pathways in regional dementia care and optimizing pharmaceutical governance through compliance with Law 648/96.
METHODS: A retrospective analysis was conducted using Marche Region prescription flows (DPC, RF and DD) for the year 2025. Costs per 25mg IR pack were compared across channels: hospital tender (DD), Regional logistic operator prices (DPC), and SSN net price (RF). To estimate the number of mis-channeled dementia patients in the DPC channel, a selection cascade was applied: age≥80 years, prescription by General Practitioners (GP), and low-dose regimen (25-50mg), yielding 6.461 patients (45,2%). A prevalence rate of 18% (based on the ILSA study) was the applied to this pool, identifying 1.163 patients (8,1%) as the eligible population. The economic impact of DPC stockouts was calculated based on 8,981 non-evaded orders converted to RF. Statistical significance: Z=12,10; p value<0,001.
RESULTS: The economic gap between distribution channels is substantial: DD cost is €0.60/pack compared to €6.50/pack for DPC (+983%) and €9.10/pack for RF (+1.417%). Analysis identified approximately 1.163 dementia patients incorrectly managed through DPC, generating an estimated avoidable expenditure of €69.444 per year (€59/patient/year). Moreover, DPC shortages forced a conversion of 8.981 packs to the RF channel, leading to an additional burden of €88.392. The total estimated regional economic impact of poor governance and supply instability is €157.836/year. A confirmed core of 176 patients correctly managed in DD showed high adherence to specialist care (97.7%) and lower average costs.
CONCLUSIONS: Correct channelling of off-label patients toward specialist care and DD pharmacies is essential for healthcare sustainability. Adhering to law 648/96 not only ensures a 10-fold reduction in drug costs per pack but also protects fragile patients from retail market shortages. Targeted communication to top-prescribing GPs and active recruitment of over-80 patients by neurologists are recommended to optimize regional pharmaceutical governance.
METHODS: A retrospective analysis was conducted using Marche Region prescription flows (DPC, RF and DD) for the year 2025. Costs per 25mg IR pack were compared across channels: hospital tender (DD), Regional logistic operator prices (DPC), and SSN net price (RF). To estimate the number of mis-channeled dementia patients in the DPC channel, a selection cascade was applied: age≥80 years, prescription by General Practitioners (GP), and low-dose regimen (25-50mg), yielding 6.461 patients (45,2%). A prevalence rate of 18% (based on the ILSA study) was the applied to this pool, identifying 1.163 patients (8,1%) as the eligible population. The economic impact of DPC stockouts was calculated based on 8,981 non-evaded orders converted to RF. Statistical significance: Z=12,10; p value<0,001.
RESULTS: The economic gap between distribution channels is substantial: DD cost is €0.60/pack compared to €6.50/pack for DPC (+983%) and €9.10/pack for RF (+1.417%). Analysis identified approximately 1.163 dementia patients incorrectly managed through DPC, generating an estimated avoidable expenditure of €69.444 per year (€59/patient/year). Moreover, DPC shortages forced a conversion of 8.981 packs to the RF channel, leading to an additional burden of €88.392. The total estimated regional economic impact of poor governance and supply instability is €157.836/year. A confirmed core of 176 patients correctly managed in DD showed high adherence to specialist care (97.7%) and lower average costs.
CONCLUSIONS: Correct channelling of off-label patients toward specialist care and DD pharmacies is essential for healthcare sustainability. Adhering to law 648/96 not only ensures a 10-fold reduction in drug costs per pack but also protects fragile patients from retail market shortages. Targeted communication to top-prescribing GPs and active recruitment of over-80 patients by neurologists are recommended to optimize regional pharmaceutical governance.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE497
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Budget Impact Analysis
Disease
Mental Health (including addiction), Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas